Early use of oral cholera vaccines as a prime control measure during outbreaks: Necessary but not sufficient.

ABSTRACT

INTRODUCTION: Despite being a preventable and treatable disease, cholera remains a public health problem in Sudan. The objective of the outbreak investigation was to identify associated risk factors that would help institute appropriate control measures. MATERIAL AND METHODS: A case control study design was chosen to identify the risk factors for cholera in Gadarif State. RESULTS: Multi-variate analysis of identified two risk factors and three preventive factors for cholera in Gadarif City. RISK FACTORS Buying foods or drinks from street vendors (OR = 71.36), 95 % CI 16.58-307.14), living in an urban setting (Gadarif City) (OR = 5.38), 95 % CI 2.10-13.81); and the preventive factors were Washing hands with water after defecation but without soap (OR = 0.16), 95 % CI 0.04-0.63) or with soap (OR = 0.01), 95 % CI 0.00-0.03), washing hands before eating (OR = 0.15), 95 % CI 0.05-0.51) and taking Oral Cholera Vaccine (OCV) (OR = 0.19, 95 % CI 0.08-0.44). The effectiveness of OCV (VE) was (Unadjusted VE 80 %, 95 % CI 69 %-87 %) or (Adjusted VE = 81.0 %, 95 % CI 56.0 %-92.0 %). DISCUSSION: Cholera outbreaks, especially in the setting of a complex humanitarian crises, can spread rapidly, resulting in many deaths, and quickly become a public health crisis. Implementation of a community-wide vaccination campaign using OCV as early as possible during the outbreak while implementing other control measures to target hotspots and at-risk populations would expedite halting outbreaks of cholera and save lives.